Care Home: Portishead House, 5

What the care home does well The project continues to provide a high standard of care and support provided by a dedicated, professional and caring staff team. This was even though the Care Manager was not present during the inspection. The care plans and risk assessments are of a high quality that focus on quality outcomes for people who use the service and promote as much input from them as possible. People who use the service are encouraged and enabled to develop the life skills required to live independently, take their own decisions and responsibility for their actions within a safe, risk assessed environment. What has improved since the last inspection? The care planning continues to move towards a more and more person centered approach and the whole service is geared to the wishes and needs of the individual. What the care home could do better: Although the physical environment is reasonable certain areas are becoming a little scruffy, particularly the communal corridors that require redecoration. Key inspection report Care homes for adults (18-65 years) Name: Address: Portishead House, 5 Westbourne Park Estate London W2 5UP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wynne Price-Rees     Date: 1 0 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Portishead House, 5 Westbourne Park Estate London W2 5UP 02072430697 02072213959 chichi@mungos.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St Mungo Association care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 14 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia -- Code MD Date of last inspection Brief description of the care home Portishead House is a registered care home for 14 men with mental health problems. One place in the home is used to provide respite care for short periods. All 14 places in the home are funded by Westminster City Councils Social Services Department. The property is owned by Paddington Churches Housing Association. The home is staffed and the care is provided by St Mungos Association, a voluntary organisation. The home is located on a housing estate close to the transport links and community facilities of Westbourne Park and Bayswater. The home is run as a rehabilitation project. People who use the service live in the home for up to three years and are supported to learn and develop the skills they need to move on to more independent accommodation. At the time of this inspection there were fourteen residents living at Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 14 1 0 1 2 2 0 0 8 Brief description of the care home the home. Care Homes for Adults (18-65 years) Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection was unannounced and took eight hours to complete over two days on the 6th and 10th of November 2009. During the inspection we talked to three people who use the service and twelve questionnaires were returned giving views about the service they receive. We also spoke to staff, care practices were observed, records and procedures checked and a premises tour undertaken. The Care Manager was on leave during the inspection. We inspected all the key inspections and the information we gathered was compared with that we have received since the last key inspection, ASR and AQQA returned to us by the project. An ASR is an annual service review that is conducted without visiting the home. An AQQA is a self-assessment document filled in by the project that tells us how they feel they are performing against the quality outcomes of the national Care Homes for Adults (18-65 years) Page 6 of 26 minimum standards. We also case tracked the care plans and files of two people who use the service. Care Homes for Adults (18-65 years) Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are fully assessed before they move in and they have a three day stay before deciding if they wish to move in. Evidence: I stayed for three days before moving in. I was asked if I wanted to move in. The project has a written assessment policy and procedure that a sample of two files of people who use the service demonstrated is followed. Referrals are mainly made by community mental health teams based within the Westminster City Council. Assessment information is forwarded to the project by the community mental health teams to determine if a placement may be appropriate and needs can be met. This information includes discharge summary, CPA care plans and reviews. The assessment information is discussed within the project team and if it is felt the placement could be appropriate the person using the service will be invited for a three day stay to help them decide if the project is where they wish to live. During the stay the person who uses the service is assessed and a three day assessment completed that includes assessments of risks. The assessment is then discussed and if the placement is considered appropriate by the project and person who uses the service Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: they are invited to move in and an initial care plan is created from the assessment that is also used to identify an appropriate key worker and co-key worker. They are identified within the first week and an initial key working session takes place that helps support the person who uses the service to get used to their new living environment. There are assessments for respite and permanent stay people who use the service. One person who uses the service came in on respite two days before the inspection visit and all the documentation required by the assessment procedure is in place. Ten of the questionnaires returned confirmed that people who use the service were asked if they wished to move in. Two said they were not. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are comprehensive and contain information that shows how staff support and enable people who use the service with their health, cultural, social and emotional needs and promote independent living. People who use the service are encouraged to make decisions for themselves within a risk assessed environment. Evidence: I am involved in my care planning. I make my own decisions. A sample of two care plans that we case tracked demonstrate that the care planning policy and procedure is followed. The organization operates an outcomes care planning star system. This identifies key areas such as self-care, living skills, motivation, handling money, mental well being, tenancy, physical health and meaningful use of time. The format used is a numbered system where the person who uses the service scores themselves on where they feel they currently are for each area on a scale of one to ten. Ten is the highest and one the lowest. The scoring is then used to identify goals with the key worker. The goals are then reviewed monthly and star outcomes after three months. These are contributed to by communication book entries, progress Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: notes and monthly key worker notes. A monthly action plan also identifies if goals set are being worked towards or are dormant. The care plan goals are underpinned by risk assessments that are reviewed quarterly or as and when required depending on the nature of the goal or changing needs. The care planning process and philosophy of the project is to enable people to make their own decisions on a daily basis and into the future with the ultimate goal of independent living. The care practices observed and way people who use the service came and went whenever and wherever they wanted supported this. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service take part in appropriate activities at home and within the community, maintain good contact with family and friends and their rights and responsibilities are recognized. They have a healthy, balanced, nutritious and varied diet. Evidence: Ive been out shopping for some winter clothes. People who use the service have access to a wide range of activities that meet their interests and development needs. One person is undertaking a course in English as a second language to further develop their communication skills and has also completed an English course at Westminster College. Someone else is attending a woodworking course at the Waterview Center and two others take part in the St Mungos led gardening project. One person also works in a shop. There are a number of leisure activities that people who use the service choose both Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: at home and externally. The gym and street football league are popular and there are also in-house cookery courses. An external life skills co-coordinator attends the project bi-weekly and they also attend another project. There is also a project worker with designated activity tasks. Good use is made of local facilities including shops, cafes, churches and cinemas. People are facilitated to have their spiritual and cultural needs met as they wish. One person who uses the service engages with a substance misuse community worker and gives talks about their experiences to the local community. A party recently took place at the project to celebrate black history month where people from other projects, family and friends were invited to attend. Family and friends also come to dinner and can stay overnight. Contact with family depends on circumstances and the wishes of people who use the project. If they express a wish to make and maintain contact staff support them to do so. The project daily routines are fitted to the individual rather than the other way around. Activities are becoming more individualized and personalized as part of the care planning system. Each person who uses the service cooks for everyone at least once per month as part of the cooking rota. They choose what they want to cook and purchase the ingredients. If the choice is not want someone wants alternatives are provided and there is an open kitchen policy where people can cook for themselves. This is part of life skill development to prepare people for independent living. Nutrition is monitored as part of health care planning and there is access to nutritionists. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have their physical and emotional health needs met. Medication is appropriately stored, administered and recorded. Evidence: A sample of two care files showed that health needs promotion is included in care planning and there are also separate health files. A record of health appointments is kept including if attended and why. All people who use the service are registered with GPs and are entitled to choose whichever GP they wish. The health files contain information regarding any specific health issues such as diabetes, weight or medical condition and these are monitored as part of health care planning. There is also a separate medication file that contains more in depth information. People who use the service have full access to community based health care services such as hospitals, CPN, opticians and they are supported to access them by staff as required. A CPN is a Community Psychiatric Nurse and they visit to provide Depot injections as required. Personal care is not provided although staff prompt and support people who use the service regarding personal hygiene as required. There is a written medication administration policy and procedure and only staff trained to do so administer medication. Currently there are two people who use the Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: service who self-medicate. Two staff members sign to record that medication has been given to them. The medication administration charts were checked for all people who use the service and found to be appropriately completed. Any medication missed is checked and recorded at the end of each shift. The project does not keep controlled drugs. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can feel confident their complaints and concerns are listened to and fully investigated with an outcome provided. They are kept safe and well protected by the project adult protection policy and procedure. Evidence: I know how and who to complain to. There is a complaints policy and procedure and records made of any complaints are fully investigated and recorded with outcomes. There are no current complaints are recorded. The project has a safeguarding adults policy and procedure. Staff spoken with are fully aware of its contents and the circumstances under which it must be operated. They know what constitutes abuse and have received adult protection training as part of induction and receive refresher training annually. They also have access to adult protection training provided by Westminster City Council. There are no current POVA issues. POVA is the protection of vulnerable adults. There is also a procedure and training in what to do if aggression is encountered from people who use the service. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a homely, comfortable and safe environment that is clean and hygienic although the communal corridors require redecoration. Evidence: I find the project comfortable to live in and it meets my needs. The project is very clean. A premises tour shows the project is suitable for its stated purpose, safe, comfortable and secure. It is reasonably well decorated with enough shared communal area to accomodate everyone. The paint is flaking away in the corridors that need redecoration. There is also a garden with sitting areas. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported by a competent, qualified staff team, protected by the recruitment process and have their needs met. Evidence: I would like more mental health training specific to the project. The training is thorough and of good quality. The staff are all good. Good support from staff regarding everything. The homes carers are always on hand to help with any issues. Currently there are no staff vacancies. The rota demonstrated that there are suitable numbers of staff on duty at all times to meet the needs of people who use the service. Staff spoken to and the care practices observed demonstrated that they are knowledgeable, dedicated and efficient whilst carrying out their duties in a friendly and supportive way. All staff have an NVQ level 2 qualification or equivalent within six months of being employed. They receive comprehensive induction training and have access to an annual rolling training programme. This includes safeguarding, medication administration, health and safety, drug and alcohol awareness, mental health risk assessment and key working. Supervision takes place monthly and there are annual performance appraisals. There is a comprehensive recruitment procedure that meets the requirements of the Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: standards and includes work history, references, CRB, qualifications and health check. CRB is the Criminal Records Bureau. Interviews incorporate a competency framework. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a well run home that is based on their views and promotes and protects their health and safety. Evidence: The Care Manager has been in post for a number of years and holds an NVQ level 4 management qualification. An idea of how well the project is managed is that they were on leave during the inspection and the project was functioning very efficiently despite their absence. There are two members of staff who share health and safety responsibilities. These include up to date annual premises risk assessments, weekly fire call point, monthly emergency lighting and twice daily fridge and freezer temperature checks. Fire drills take place six monthly during the day and quarterly at night. The fire risk assessment was updated in September 2009 and a PAT test in January 2009. PAT tests are tests of all portable electrical equipment brought into the home. There are up to date accident and incident records and an annual COSSH review took place in February 2009. COSSH is the control of exposure to hazardous waste. The building is also checked daily. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The quality assurance system operated by the project and organization identifies any shortfalls in standards. It has identifiable performance indicators and trigger levels that are regularly reviewed. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 23 The communal corridors must be decorated. The paintwork in the communal corridors is flaking and worn. 01/04/2011 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 35 The home should consider more mental health training specific to the project. Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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